How does health insurance work
- Thread starter LeslieS
- Start date
- Location
- Throggs Neck, BX
Depends on the procedure Leslie as well as the amount of time spent in the hospital. Some procedures medical insurance will cover up to a certain limit and certain amount of time. You should really speak to your medical coverage provider for answers.
I don't have to pay anything other than my deductible. I am just curious why the drs./hospitals bill one amount and accept a much lower amount from the health insurance company. If I had to pay this myself, could I negotiate a lower amount as well?
- Location
- New Rochelle
A lot of times, doctors and hospital overbill their services. If they accept your insurance i.e. they are in network providers, they have to accept the rate that the insurance company set for them and write off the rest. If they bill you for the remaining, it is illegal and against their contract agreement. If your deductible is $500 let say per year, that's the most you have to pay out of pocket.
On the other hand, if you go to someone out of network, let say I have BCBS PPO, I can go to any doctors even the ones don't accept my BCBS. There are doctors who don't want to participate with certain insurance Co. b/c crapy reimbursement. They can charge you whatever they want. Usually the insur. Co. paid them more than the doctors who participate, much more. But the rest of the bill, the patient becomes responsible. But as a general rule, the doctor shall tell the patient ahead of time that he/she is not the network provider. If he/she is happy with the out of network reimbursement by the insur. Co., he/she might not bill you for the rest.
Now, in case of emergency, most if not all insur. Co. policies require full coverage whether the doctor/hospital is accepting your insur or not. So a non-participating doctor can bill you whatever and it is your insur. co. to negotiate with them regarding the payment. You should not have to pay anything other than the deductible.
Hope it helps. Health care insurance industries are the biggest scam of the century IMO. How can they be traded on wall street? They are taking money from the patients and the hardwork of the doctors, nurses and hospital staffs and squeeze as much money out of them as possible to make a profit.
So if I had to pay the entire thing myself, it would cost 16,000, but the insurance company negotiates lower rates up front. If I come across something that my health insurance doesn't cover, I am going to try to negotiate lower rates up front as well
But wait....if I make my Dr. mad at me, it could get really ugly....better just go with whatever it is I have to pay!
But wait....if I make my Dr. mad at me, it could get really ugly....better just go with whatever it is I have to pay!
- Location
- New Rochelle
...If I come across something that my health insurance doesn't cover, I am going to try to negotiate lower rates up front as well
That's what people do when they go to a plastic surgeon!! I wish I was a plastic surgeon. But yet, they are not real doctor (Why do they even need to go to medical school since most of what they learn in school do not apply to what they do.):shhh:
- Location
- Melville, NY
That is also why some doctors dont accept some insurance companys. The amounts they pay for said proceedures differ from insurance company to insurance compnay. Some doctors wont take the crappier insurance because it isnt worth what they pay.
- Location
- New Rochelle
True. But unless they have an exclusive clientele or something that separate them from the pack, they have no options but to accept them in todays environment.
- Location
- Philippines
iS anybody eLse wonderinG what LesLie had done for $16,000 :Blurp: :flirt: :shhh:
Not to get off the subject but I have aflac which pays me if I get injured at work. I just got hurt at work at the beginning of the summer ( knee surgery) and after all is said and done I was cut a check for $1400. I pay about $32 a month for this type of accident insurance. If you are in a physically demanding job it is worth it to have...
- Location
- Staten Island
iS anybody eLse wonderinG what LesLie had done for $16,000 :Blurp: :flirt: :shhh:
LMAO Yeah... I hope all is well now...
- Location
- poughquag, ny
almost the same with auto insurance, my shop rate is x amount insurance rate is x amount and i work at that rate instead of my shop rate
- Location
- Philippines
tHe NEW LesLie :wow:
:wow:
So if I had to pay the entire thing myself, it would cost 16,000, but the insurance company negotiates lower rates up front. If I come across something that my health insurance doesn't cover, I am going to try to negotiate lower rates up front as well
But wait....if I make my Dr. mad at me, it could get really ugly....better just go with whatever it is I have to pay!
If you think thats bad, if you had a procedure done, the insurance company can be billed and pay lets say $8,000. If the insurance doesnt pay because its not a covered expense, you get charged $8,000 + TAX. If you are having trouble with your insurance I can give you some pointers as I've had a long saga with them over the last 10 years due to some major medical issues.
To be fair, the blame is not all the insurance companies. There's plenty of it to go around - including patients who dont take care of themselves and have unrealistic expectations from doctors ( fed by such documentaries as House M.D. and ER ).
This is not true, you can negotiate. The best thing is to be up front with the doctor BEFORE the visit. Often times doctor's will not charge you as much as they charge the insurance companies, if you are paying out of pocket, because of the fact that insurance companies ( just like car insurance and others ) will pretty much always pay only a percentage of the actual billed charges so doctor's have to play the game and figure out how to bill as much as possible in order to stay afloat. If two doctor's perform the same procedure but one has a better billing personell who knows how to code up ( all procedures, etc. are listed in a big fat book with codes that are used for classification and reimbursement purposes ) than that doctor will get paid more.
Another issue is, that unlike your lawyer, your doctor does not get paid for the midnight phone calls, the extra half hour he spent talking to you, or stopping by in your hospital room on his lunch break. Doctor's get paid for PROCEDURES first and foremost, and a small base pay for just the visit which is why many many medical students are drawn into the procedure heavy specialties ( hey they have their $300,000 in loans to pay back before they can see a return on their 15 years of hard work ) rather than primary care which is needed most.
Plastic surgery is not just about boobs and botox. Burns, facial injuries, etc. are a big part of it. I used to think that its all about cosmetics and big bucks and then I sat through an anatomy lecture from a top-notch facial reconstructionist specialist. Seeing what he's done for people with major tumors of the face, gunshot victims, not to mention poor village kids in China with cleft palate, really gave me a lot of respect for the field.
- Location
- New Rochelle
You are talking about less than 10% of the plastic surgeons in the country who do make a real difference.
I wouldnt know as I havent done a survey but as long as my insurance premiums and tax dollars are not subsidizing cosmetic surgery, than good for them. Its the freeloaders that really get me - people who walk around in $500 outfits but go to the free clinic, I mean ER because they dont want to buy insurance or $50 for an office visit for their cold.
i got a 4500.00 operation and had no insurance they looked at my income and took off 69.9% of the bill .that was the hospital .my surgeon bill was 1700.00 and i had to pay 451.00 so yes they work with you . im self employed and my imcome is shown as being low , most of my money goes back into shop for improvements etc,and we live off my wifes income for now . so yes they work with you but its being abused by the welfare system , they pay hospitals big money for the same operation ! seems crazy cause it comes out of the taxpayers pocket to pay for the welfare system . i do not believe that this is right ,if they will cut costs for me why not for the government ?simply put its a scam in my eyes ! thats all i got to say about that , happy fishing because thats whats important ! almost forgot the bill for the two people it took to sedate me during the operation was 1600.00 dollars that cost was not reduced one penny ! they gave me a mild seditive and used novacane in the area to be cut open for a total of 1600.00 ! obserd amount for that type of operation ! i had a hernia , not that complicated in the sceme of things . i was out for 35 minutes no e k g hooked to me ,just a little sleepy pill they said before the operation ,wish i could sell them some SLEEPY PILLS i would be a zillionair ! ok i'm done , blood pressure is skyrocketing ! not really lol.
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